"The current diagnosis pathway can result in various errors: clinically indolent cancers are identified by chance; clinically significant lesions are missed; important cancers are incorrectly classified as unimportant; and men undergo whole-gland treatment, which carries harm," said co-investigator and presenter Hashim Ahmed, PhD, an MRC clinician scientist at University College London Hospitals in the United Kingdom.

Because MP-MRI as a triage test might allow men to avoid unnecessary TRUS-biopsy, since men with an elevated PSA do not have clinically significant prostate cancer, researchers evaluated the accuracy of MP-MRI followed by TRUS-biopsy vs template prostate mapping biopsy (TPM-biopsy) as an accurate reference test.

For the prospective, paired-cohort confirmatory PROMIS study, investigators enrolled 740 men with an elevated PSA up to 15 ng/mL who had not undergone prior biopsy.

All men underwent MP-MRI followed by both TRUS-biopsy and TPM-biopsy. All patients and physicians were blinded to MP-MRI reports and radiologists were not present at the time of biopsy; pathologists reading biopsy reports were blinded to MP-MRI reports; and TPM-biopsy and TRUS-biopsy reports were sent to different expert uro-pathologists.

The investigators determined that using MP-MRI as a triage test would avoid a primary biopsy in 27% of men at the minimum but detect 18% more cases of clinically significant cancer than the standard TRUS-biopsy.

"The high sensitivity and negative predictive value of prostate MP-MRI at 1.5 Tesla justify its use as a triage test to identify those men who might avoid a primary biopsy," Dr Ahmed explained. "The low specificity and positive predictive value of prostate MP-MRI indicated that men with suspicious MP-MRI still require a biopsy."

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